Articles: general-anesthesia.
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The ideal neuromuscular blocking drug for dental and other outpatient procedures would be nondepolarizing (therefore reversible), highly potent, have a rapid onset and short duration of action, be highly specific for the nicotinic acetylcholine receptor, be eliminated independently of renal or hepatic metabolism, and have minimal side effects such as tachycardia and histamine release. The newer neuromuscular blocking drugs vecuronium and atracurium approach this ideal much more closely than the older drugs curare, metocurine, and gallamine. Aside from considerations of slightly higher cost, the neuromuscular blocking agents of choice remain succinylcholine for rapid, short-lived paralysis, vecuronium and atracurium for relaxation of 15- to 60-minute duration and when cardiovascular stability is vital, and pancuronium for longer surgical procedures. Vecuronium and atracurium have achieved and will continue to achieve predominance in the anesthetic management of the short-procedure patient.
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J. Oral Maxillofac. Surg. · Jan 1987
Use of capnography and transcutaneous oxygen monitoring during outpatient general anesthesia for oral surgery.
The combination of the capnograph (respired CO2 monitor) and the transcutaneous oxygen monitor was evaluated as a non-invasive system for monitoring of respiratory function in 10 ASA class I patients undergoing ultralight general anesthesia for removal of third molars. Capnography proved to be a sensitive and accurate method for detecting apnea and airway obstruction using the continuous display of the CO2 waveform. All episodes of apnea or obstruction were immediately detected as the respired CO2 level fell to zero baseline. ⋯ During steady-state conditions of respiration, transcutaneous oxygen tensions (PtcO2) correlated well with simultaneously measured PaO2 (r = 0.93). However, during any period when oxygenation was rapidly changing (step increase in FIO2, step decrease in FIO2, or apnea) the PtcO2 lagged behind changes in PaO2 even after a five-minute equilibration period, thereby not accurately reflecting the true state of oxygenation. Consequently, the transcutaneous oxygen monitor does not appear to be optimal as a respiratory monitor in the setting of ultralight general anesthesia where rapid, critical changes in oxygenation must be detected without delay.
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Dent. Clin. North Am. · Jan 1987
Historical ArticleAnesthetic management. Historical, present, future.
This article deals with specific agents that either have been or are being employed for the production of general anesthesia or sedative states for the control of pain or anxiety in the dental setting. Change, progress, trends, and contributions to the field of dental anesthesia made by dentists are stressed. In addition, a brief synopsis of the most popular present-day techniques and agents is discussed. Finally, the future of the field of dental anesthesia and the role to be played by dentists is considered.
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General anesthesia is provided in the dental office primarily to reduce fear, block pain, produce amnesia, and provide a more comfortable surgical environment. Because the perception of pain is a major obstacle to the obtainment of dental health in the United States, general anesthesia has become an essential part of the practice of dentistry. It benefits both the patient and the surgeon to make dentistry a pleasant, painless experience.
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Randomized Controlled Trial Clinical Trial
Minor complications following anaesthesia in young adults for orthopaedic surgery of the lower extremity.
In all, 175 young (15-40 yr) patients received either spinal anaesthesia with bupivacaine (104 patients) or general, balanced anaesthesia (71 patients) for orthopaedic surgery of the lower extremities. Each patient was interviewed before the operation, problems that arose during the operation were recorded and all patients were interviewed on the first postoperative day. One hundred and seven patients were interviewed after being discharged, 1-3 months after the operation. ⋯ All these problems had ceased at the interview 1-3 months later. Eight (six spinal and two general anaesthesia patients) were not satisfied with the method of anaesthesia used. This study revealed that an appreciable number of young patients have complications after anaesthesia, but the complications are minor and self-limited.